Treating Hypertension and Heart Disease without drugs
While working in Zululand as a third year medical student, it was not hard to make an observation on the cause of our modern epidemic of heart disease. Every day our truck drove from the hospital to a different outlying clinic at a farmhouse where the people would line up to be seen. (I eventually became adept at quick tooth extractions). In the interior of Zululand where people worked the land and ate what they sowed, we saw infections and malnutrition but none of the ubiquitous urban diseases of America. In other clinics where Zululand bordered industrial towns and people held jobs in the factories, we saw diseases that were rare in the rural clinics: hypertension, diabetes, coronary disease and strokes.
A year later at a major medical center in Delhi, I attended rounds in two cardiology clinics: the valve clinic and the coronary clinic. In the valve clinic, I needed an interpreter because no one spoke English. The patients came from farm villages. They had acquired a strep infection, and lacking access to penicillin, had developed rheumatic fever that destroyed their valves. In the coronary clinic everyone spoke perfect, cultured English, usually with a British accent. They were from business and professional families from the city. I never needed an interpreter. It didn't take me long to conclude that our modern epidemic of vessel disease and its primary risk factors (hypertension, diabetes, obesity, smoking, lack of exercise and high cholesterol) could mostly be eliminated if we could somehow abandon our overfed, sedentary and stressful lifestyles.
There has been a 50% reduction in fatal strokes and heart attacks in the U.S. over the past quarter century accounting for 70% of our 5.6 year increase in life expectancy. Despite these improvements odds are better than 50/50 that any given North American will still eventually surrender to the ravages of vascular disease.
This month the New England Journal of Medicine reported that less than a quarter of the population with high blood pressure in a large national survey had adequate control. Other studies have shown that half of people who start medications will have stopped them in a year, allowing their BP to rise because they could not tolerate the side effects. Half of my own patients will also have stopped their medication, but their pressure is controlled with natural methods. Admittedly, I have special, highly motivated patients.
Ayurveda, the medical science of the ancient Vedic civilization, has a long history of treating hypertension, even pre-dating the invention of the blood pressure cuff. In fact, the first antihypertensive medication was an Ayurvedic plant, rauwolfia serpentina, known as sarpagandha in Sanskrit, and traditionally used for tension, excitability and other mental disorders. The active ingredient, reserpine, was isolated in 1952, and ever since reserpine has been infamous among doctors for its side-effects, clearly demonstrating the fallacy of seeking progress through isolating and using an active ingredient extracted from the whole plant.
I believe in aggressive treatment of blood pressure, even in the elderly, where careful control of BP has been shown to reduce dementia by 50%. However, I also believe in aggressive lifestyle changes to reduce the need for pills. Besides herbs, there are other scientifically documented ways anyone can reduce their blood pressure without drugs. Here is my short list:
- Avoid salt. Add it only in moderation while cooking and refrain from reaching for the salt shaker at the table. Especially avoid packaged and prepared foods which are high in sodium such as snacks, frozen meals, macaroni and cheese, and other convenience meals. Good for a reduction of 5-10 mm HG.
- Cultivate a taste for a diet that focuses on fresh produce, grains and low-fat dairy. Favor fruits and vegetables in abundance and reduce meat and other high fat foods. This ancient Ayurvedic prescription for long life has now been dubbed the DASH diet (Dietary Approaches to Stop Hypertension). Combined with salt reduction, good for another 5-10 mm HG.
- Lose any extra pounds. Weight is a factor in today's high blood pressure epidemic because we are also in an epidemic of obesity, and extra pounds increase the resistance to blood flow. Another 5-10 mm Hg.
- Get in shape. Exercise promotes the flow of blood to muscles and other organs, thereby lowering the resistance to blood flow that causes hypertension. It's that simple. 5-6 mm Hg.
Stop smoking. Have you noticed how smoking makes your hands and feet feel cold? This is the result of constriction of your blood vessels. Count on 5-6 mm Hg.
- Extra potassium in the diet. Forget supplements, just take plenty of fruit and vegetables, especially citrus.
- Extra magnesium. Again, why take supplements when fruits and vegetables are nature's perfectly balanced food, as well as much more fun to swallow.
- Garlic. Only fresh, never powdered or extracts which quickly become rancid. Several studies have shown they can knock off 2-3 mm Hg.
- Transcendental Meditation. Twelve published studies, the most recent sponsored by the National Institutes of Health, have shown reductions of 8-10 mm Hg not seen in control groups doing mindfulness meditation and progressive muscular relaxation. Several studies were done in the most resistant types of blood pressure including elderly, inner city blacks. Moreover, groups doing TM had a reduction in the thickness of the lining of their carotid artery, reflecting less deposition of plaque.
- Other stress management. Avoid traffic jams, needless confrontations and other behaviors that make you irritated. 2-5 mm Hg.
Add them up and knock off some points just to be realistic. I rarely find a patient on blood pressure pills who cannot reduce or sometimes even discard them within a year. The ticket off your pills is to own a cuff, because when you see your doctor, your BP will be higher than it is at home (white coat hypertension). You need to show your doctor a diary with 20-30 readings each time you go in. A reliable electronic one is a good investment because they are easier to operate and can't cheat. Record the date, time of day and comments about your frame of mind, diet and lifestyle next to the reading so you can identify factors that raise or lower your pressure. As you change your diet, lose weight, exercise and meditate, your BP will trend down and your doctor may taper your dose. If in spite of your best efforts you still need your pills, the lifestyle changes will make you feel better and prevent other problems as well.
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